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Ryan J Lennon - One of the best experts on this subject based on the ideXlab platform.
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pharmacoinvasive and primary percutaneous coronary intervention strategies in st elevation myocardial infarction from The Mayo Clinic stemi network
American Journal of Cardiology, 2016Co-Authors: Ryan J Lennon, Malcolm R Bell, Konstantinos C Siontis, Gregory W Barsness, Jody L Holmen, Scott R Wright, Bernard J. GershAbstract:The effectiveness of a pharmacoinvasive strategy consisting of fibrinolysis and transfer for percutaneous coronary intervention (PCI) compared to primary PCI (PPCI) in patients presenting to non–PCI-capable hospitals with ST-elevation myocardial infarction (STEMI) is not well defined. We analyzed data from The Mayo Clinic STEMI database of patients treated with a pharmacoinvasive strategy (favored in those presenting early after symptom onset) or PPCI in a regional STEMI network from 2004 to 2012. A total of 364 and 1,337 patients were included in The pharmacoinvasive and PPCI groups, respectively. Patients in The PPCI group were older and more frequently had cardiogenic shock at The time of presentation (12.1% vs 7.7%, p = 0.018). Death from any cause occurred in 58 (16%) and 314 (23%) patients in The pharmacoinvasive and PPCI groups, respectively (median follow-up 3.9 and 4.4 years, respectively). In multivariate analyses adjusting for age, gender, and oTher variables for which The 2 groups differed at baseline, There was no significant difference between The 2 strategies for 30-day (hazard ratio 0.66, 95% confidence interval 0.36 to 1.21) or overall mortality (hazard ratio 0.84, 95% confidence interval 0.63 to 1.12). Shorter door-to-balloon time was associated with increased effectiveness of PPCI (p for trend = 0.015), but There was no difference between The 2 strategies even when considering only The patients with door-to-balloon time in The lowest quartile. In conclusion, fibrinolysis followed by transfer for PCI represents a reasonable alternative when PPCI is not readily available especially in patients presenting early after symptom onset.
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The prevalence of cardiovascular disease risk factors and The framingham risk score in patients undergoing percutaneous intervention over The last 17 years by gender time trend analysis from The Mayo Clinic pci registry
Journal of Preventive Medicine and Public Health, 2014Co-Authors: Moo Sik Lee, Ryan J Lennon, Andreas J Flammer, Hyunsoo Kim, Jeeyoung Hong, Amir LermanAbstract:Objectives This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at The Mayo Clinic. Methods We performed a time-trend analysis within The Mayo Clinic PCI Registry from 1994 to 2010. Results were The incidence and prevalence of CVD risk factors as estimate by The Framingham risk score. Results Between 1994 and 2010, 25 519 patients underwent a PCI. During The time assessed, The mean age at PCI became older, but The gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to The Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. Conclusions Most of The major risk factors improved and The FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced The positive trends. Objectives This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at The Mayo Clinic. Methods We performed a time-trend analysis within The Mayo Clinic PCI Registry from 1994 to 2010. Results were The incidence and prevalence of CVD risk factors as estimate by The Framingham risk score. Results Between 1994 and 2010, 25 519 patients underwent a PCI. During The time assessed, The mean age at PCI became older, but The gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to The Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. Conclusions Most of The major risk factors improved and The FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced The positive trends.
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time trend analysis on The framingham risk score and prevalence of cardiovascular risk factors in patients undergoing percutaneous coronary intervention without prior history of coronary vascular disease over The last 17 years a study from The Mayo Clinic pci registry
Clinical Cardiology, 2014Co-Authors: Ryan J Lennon, Charanjit S Rihal, David R Holmes, Moo Sik Lee, Andreas J Flammer, Mandeep Singh, Amir LermanAbstract:Background There is a paucity of data on The temporal trends of cardiovascular risk factors in patients undergoing percutaneous coronary intervention (PCI). We investigated The secular trends of risk profiles of patients undergoing PCI without prior history of cardiovascular disease (CVD). HypoThesis CVD risk factors are changed over time. Methods This time-trend analysis from 1994 to 2010 was performed within The Mayo Clinic PCI Registry. Outcome measures were prevalence of CVD risk factors, including The Framingham risk score (FRS), at The time of admission for PCI. Results During this period, 12,055 patients without a history of CVD (mean age, 65.0 ± 12.4 years, 67% male) underwent PCI at The Mayo Clinic. Age distribution slightly shifted toward older age (P for trend <0.05), but sex did not change over time. Despite a higher prevalence of hypertension, hypercholesterolemia, and diabetes mellitus over time, actual blood pressure and lipid profiles improved (P for trend <0.001). Over time, FRS and 10-year CVD risk improved significantly (7.3 ± 3.2 to 6.5 ± 3.3, P for trend <0.001; and 11.0 to 9.0, P for trend <0.001, respectively). Body mass index, not included in The FRS, increased significantly (29.0 ± 5.2 to 30.1 ± 6.2 kg/m2, P for trend <0.001), whereas smoking prevalence did not change. Conclusions The current study demonstrates that although traditional FRS and its associated predicted 10-year cardiovascular risk declined over time, The prevalence of risk factors increased in patients undergoing PCI. The study suggests The need for a new risk-factor assessment in this patient population.
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systems of care to improve timeliness of reperfusion Therapy for st segment elevation myocardial infarction during off hours The Mayo Clinic stemi protocol
Jacc-cardiovascular Interventions, 2008Co-Authors: David R Holmes, Luis H Haro, Christine M Bjerke, Ryan J Lennon, Malcolm R Bell, Charanjit S Rihal, Bernard J. Gersh, Choon Chern Lim, Henry H TingAbstract:Objectives We implemented The Mayo Clinic ST-segment elevation myocardial infarction (STEMI) protocol and evaluated The timeliness of reperfusion Therapy during off hours versus regular hours. Background Patients with STEMI who present during off hours have longer door-to-balloon times and door-to-needle times. Methods The Mayo STEMI protocol was implemented in May 2004 to optimize timeliness of reperfusion Therapy for STEMI patients presenting to Saint Marys Hospital, a tertiary facility with on-site percutaneous coronary intervention (PCI), and for those presenting to 28 regional hospitals located up to 150 miles away from Saint Marys Hospital. We compared door-to-balloon times and door-to-needle times for 597 consecutive patients who presented during off hours (weekdays from 5 pm to 7 am and any time on weekends or holidays) versus regular hours (weekdays from 7 am to 5 pm). In 2003, prior to implementing The protocol, median door-to-balloon time at Saint Marys Hospital was 85 min during regular hours and 98 min during off hours. Results Among 258 patients who presented to Saint Marys Hospital, median door-to-balloon time was 65 min during regular hours versus 74 min during off hours (p = 0.085). Among 105 patients transferred from regional hospitals for primary PCI, median door-to-balloon time was 118 min during regular hours versus 114 min during off hours (p = 0.15). Among 131 patients treated with fibrinolytic Therapy at regional hospitals, median door-to-needle time was 21 min during regular hours versus 26 min during off hours (p = 0.067). Conclusions The Mayo Clinic STEMI protocol demonstrates The rapid times that can be achieved through coordinated systems of care for STEMI patients presenting during off hours and regular hours.
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regional systems of care to optimize timeliness of reperfusion Therapy for st elevation myocardial infarction The Mayo Clinic stemi protocol
Circulation, 2007Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R BellAbstract:Background— Quality improvement efforts have focused on strategies to improve The timeliness of reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize The timeliness of reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. Methods and Results— The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Mar...
David R Holmes - One of the best experts on this subject based on the ideXlab platform.
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time trend analysis on The framingham risk score and prevalence of cardiovascular risk factors in patients undergoing percutaneous coronary intervention without prior history of coronary vascular disease over The last 17 years a study from The Mayo Clinic pci registry
Clinical Cardiology, 2014Co-Authors: Ryan J Lennon, Charanjit S Rihal, David R Holmes, Moo Sik Lee, Andreas J Flammer, Mandeep Singh, Amir LermanAbstract:Background There is a paucity of data on The temporal trends of cardiovascular risk factors in patients undergoing percutaneous coronary intervention (PCI). We investigated The secular trends of risk profiles of patients undergoing PCI without prior history of cardiovascular disease (CVD). HypoThesis CVD risk factors are changed over time. Methods This time-trend analysis from 1994 to 2010 was performed within The Mayo Clinic PCI Registry. Outcome measures were prevalence of CVD risk factors, including The Framingham risk score (FRS), at The time of admission for PCI. Results During this period, 12,055 patients without a history of CVD (mean age, 65.0 ± 12.4 years, 67% male) underwent PCI at The Mayo Clinic. Age distribution slightly shifted toward older age (P for trend <0.05), but sex did not change over time. Despite a higher prevalence of hypertension, hypercholesterolemia, and diabetes mellitus over time, actual blood pressure and lipid profiles improved (P for trend <0.001). Over time, FRS and 10-year CVD risk improved significantly (7.3 ± 3.2 to 6.5 ± 3.3, P for trend <0.001; and 11.0 to 9.0, P for trend <0.001, respectively). Body mass index, not included in The FRS, increased significantly (29.0 ± 5.2 to 30.1 ± 6.2 kg/m2, P for trend <0.001), whereas smoking prevalence did not change. Conclusions The current study demonstrates that although traditional FRS and its associated predicted 10-year cardiovascular risk declined over time, The prevalence of risk factors increased in patients undergoing PCI. The study suggests The need for a new risk-factor assessment in this patient population.
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systems of care to improve timeliness of reperfusion Therapy for st segment elevation myocardial infarction during off hours The Mayo Clinic stemi protocol
Jacc-cardiovascular Interventions, 2008Co-Authors: David R Holmes, Luis H Haro, Christine M Bjerke, Ryan J Lennon, Malcolm R Bell, Charanjit S Rihal, Bernard J. Gersh, Choon Chern Lim, Henry H TingAbstract:Objectives We implemented The Mayo Clinic ST-segment elevation myocardial infarction (STEMI) protocol and evaluated The timeliness of reperfusion Therapy during off hours versus regular hours. Background Patients with STEMI who present during off hours have longer door-to-balloon times and door-to-needle times. Methods The Mayo STEMI protocol was implemented in May 2004 to optimize timeliness of reperfusion Therapy for STEMI patients presenting to Saint Marys Hospital, a tertiary facility with on-site percutaneous coronary intervention (PCI), and for those presenting to 28 regional hospitals located up to 150 miles away from Saint Marys Hospital. We compared door-to-balloon times and door-to-needle times for 597 consecutive patients who presented during off hours (weekdays from 5 pm to 7 am and any time on weekends or holidays) versus regular hours (weekdays from 7 am to 5 pm). In 2003, prior to implementing The protocol, median door-to-balloon time at Saint Marys Hospital was 85 min during regular hours and 98 min during off hours. Results Among 258 patients who presented to Saint Marys Hospital, median door-to-balloon time was 65 min during regular hours versus 74 min during off hours (p = 0.085). Among 105 patients transferred from regional hospitals for primary PCI, median door-to-balloon time was 118 min during regular hours versus 114 min during off hours (p = 0.15). Among 131 patients treated with fibrinolytic Therapy at regional hospitals, median door-to-needle time was 21 min during regular hours versus 26 min during off hours (p = 0.067). Conclusions The Mayo Clinic STEMI protocol demonstrates The rapid times that can be achieved through coordinated systems of care for STEMI patients presenting during off hours and regular hours.
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regional systems of care to optimize timeliness of reperfusion Therapy for st elevation myocardial infarction The Mayo Clinic stemi protocol
Circulation, 2007Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R BellAbstract:Background— Quality improvement efforts have focused on strategies to improve The timeliness of reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize The timeliness of reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. Methods and Results— The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Mar...
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regional systems of care to optimize timeliness of reperfusion Therapy for st elevation myocardial infarction The Mayo Clinic stemi protocol
Circulation, 2007Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R BellAbstract:BACKGROUND: Quality improvement efforts have focused on strategies to improve The timeliness of reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize The timeliness of reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. METHODS AND RESULTS: The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Marys Hospital and were treated with primary PCI (group A), 105 patients who presented to a regional hospital with symptom onset >3 hours and Then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset <3 hours and were treated with full-dose fibrinolytic Therapy (group C). For groups A and B, median door-to-balloon times were 71 and 116 minutes, respectively. Door-to-balloon time <90 minutes was achieved in 75% of group A and 12% of group B. Median door-to-needle time was 25 minutes for group C, and 70% had door-to-needle time <30 minutes. CONCLUSIONS: The Mayo Clinic ST-elevation myocardial infarction protocol demonstrates The feasibility of implementing strategies to optimize The timeliness of reperfusion Therapy and The times that can be achieved through coordinated systems of care for ST-elevation myocardial infarction patients presenting to a PCI center (Saint Marys Hospital) and 28 regional hospitals without PCI capability located up to 150 miles away across 3 states.
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trends in outcomes after percutaneous coronary intervention for chronic total occlusions a 25 year experience from The Mayo Clinic
Journal of the American College of Cardiology, 2007Co-Authors: Abhiram Prasad, Ryan J Lennon, Charanjit S Rihal, Heather J Wiste, Mandeep Singh, David R HolmesAbstract:Objectives The aim of our study was to examine The trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over The last 25 years from a single PCI registry and to examine The impact of drug-eluting stents. Background The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and There are limited data available from contemporary practice. Methods We evaluated The outcomes of 1,262 patients from The Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to The time of Their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era). Results Procedural success rates were 51%, 72%, 73%, and 70% (p Conclusions Procedural success rates for CTO have not improved over time in The stent era, highlighting The need to develop new techniques and devices. Compared with The prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%.
Bernard J. Gersh - One of the best experts on this subject based on the ideXlab platform.
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non sustained ventricular tachycardia in exercise testing not so benign
Journal of the American College of Cardiology, 2018Co-Authors: Deepak Padmanabhan, Nasir Hussain, Thomas G Allison, Bernard J. GershAbstract:Relevance of non-sustained ventricular tachycardia (NSVT) recorded during treadmill exercise testing (TMET) is unknown. Residents of Olmsted and neighboring counties undergoing Clinically indicated TMET with The Bruce or modified McNaughton protocol at The Mayo Clinic Rochester, Minnesota between
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pharmacoinvasive and primary percutaneous coronary intervention strategies in st elevation myocardial infarction from The Mayo Clinic stemi network
American Journal of Cardiology, 2016Co-Authors: Ryan J Lennon, Malcolm R Bell, Konstantinos C Siontis, Gregory W Barsness, Jody L Holmen, Scott R Wright, Bernard J. GershAbstract:The effectiveness of a pharmacoinvasive strategy consisting of fibrinolysis and transfer for percutaneous coronary intervention (PCI) compared to primary PCI (PPCI) in patients presenting to non–PCI-capable hospitals with ST-elevation myocardial infarction (STEMI) is not well defined. We analyzed data from The Mayo Clinic STEMI database of patients treated with a pharmacoinvasive strategy (favored in those presenting early after symptom onset) or PPCI in a regional STEMI network from 2004 to 2012. A total of 364 and 1,337 patients were included in The pharmacoinvasive and PPCI groups, respectively. Patients in The PPCI group were older and more frequently had cardiogenic shock at The time of presentation (12.1% vs 7.7%, p = 0.018). Death from any cause occurred in 58 (16%) and 314 (23%) patients in The pharmacoinvasive and PPCI groups, respectively (median follow-up 3.9 and 4.4 years, respectively). In multivariate analyses adjusting for age, gender, and oTher variables for which The 2 groups differed at baseline, There was no significant difference between The 2 strategies for 30-day (hazard ratio 0.66, 95% confidence interval 0.36 to 1.21) or overall mortality (hazard ratio 0.84, 95% confidence interval 0.63 to 1.12). Shorter door-to-balloon time was associated with increased effectiveness of PPCI (p for trend = 0.015), but There was no difference between The 2 strategies even when considering only The patients with door-to-balloon time in The lowest quartile. In conclusion, fibrinolysis followed by transfer for PCI represents a reasonable alternative when PPCI is not readily available especially in patients presenting early after symptom onset.
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systems of care to improve timeliness of reperfusion Therapy for st segment elevation myocardial infarction during off hours The Mayo Clinic stemi protocol
Jacc-cardiovascular Interventions, 2008Co-Authors: David R Holmes, Luis H Haro, Christine M Bjerke, Ryan J Lennon, Malcolm R Bell, Charanjit S Rihal, Bernard J. Gersh, Choon Chern Lim, Henry H TingAbstract:Objectives We implemented The Mayo Clinic ST-segment elevation myocardial infarction (STEMI) protocol and evaluated The timeliness of reperfusion Therapy during off hours versus regular hours. Background Patients with STEMI who present during off hours have longer door-to-balloon times and door-to-needle times. Methods The Mayo STEMI protocol was implemented in May 2004 to optimize timeliness of reperfusion Therapy for STEMI patients presenting to Saint Marys Hospital, a tertiary facility with on-site percutaneous coronary intervention (PCI), and for those presenting to 28 regional hospitals located up to 150 miles away from Saint Marys Hospital. We compared door-to-balloon times and door-to-needle times for 597 consecutive patients who presented during off hours (weekdays from 5 pm to 7 am and any time on weekends or holidays) versus regular hours (weekdays from 7 am to 5 pm). In 2003, prior to implementing The protocol, median door-to-balloon time at Saint Marys Hospital was 85 min during regular hours and 98 min during off hours. Results Among 258 patients who presented to Saint Marys Hospital, median door-to-balloon time was 65 min during regular hours versus 74 min during off hours (p = 0.085). Among 105 patients transferred from regional hospitals for primary PCI, median door-to-balloon time was 118 min during regular hours versus 114 min during off hours (p = 0.15). Among 131 patients treated with fibrinolytic Therapy at regional hospitals, median door-to-needle time was 21 min during regular hours versus 26 min during off hours (p = 0.067). Conclusions The Mayo Clinic STEMI protocol demonstrates The rapid times that can be achieved through coordinated systems of care for STEMI patients presenting during off hours and regular hours.
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surgery insight septal myectomy for obstructive hypertrophic cardiomyopathy The Mayo Clinic experience
Nature Reviews Cardiology, 2007Co-Authors: Joseph A Dearani, Bernard J. Gersh, Hartzell V Schaff, Steve R Ommen, Gordon K DanielsonAbstract:In this educational Surgery Insight, Dearani and colleagues draw on The extensive experience with septal myectomy as a surgical option for patients with obstructive hypertrophic cardiomyopathy gained at The Mayo Clinic, Rochester, MN, USA. Septal myectomy has been The gold standard treatment for The relief left ventricular outflow tract obstruction and cardiac symptoms in both adults and children with obstructive hypertrophic cardiomyopathy. In almost all circumstances, abnormalities of The mitral valve and subvalvar mitral apparatus can be managed without The need for mitral valve replacement, and oTher cardiac lesions can be repaired simultaneously. In The current era, The operative mortality for isolated septal myectomy at an experienced center is low in both children and adults (approximately 1%). Excellent late results with myectomy are gratifying: 90% of patients improve by at least one NYHA class, and improvements persist in most individuals on late follow-up. Late survival in patients with obstructive hypertrophic cardiomyopathy who undergo myectomy exceeds that of patients who do not receive surgical treatment and, in addition, myectomy may be associated with reduced long-term risk of sudden cardiac death. These results should serve as a basis for comparison with newer nonsurgical treatment regimens.
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regional systems of care to optimize timeliness of reperfusion Therapy for st elevation myocardial infarction The Mayo Clinic stemi protocol
Circulation, 2007Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R BellAbstract:Background— Quality improvement efforts have focused on strategies to improve The timeliness of reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize The timeliness of reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. Methods and Results— The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Mar...
Charanjit S Rihal - One of the best experts on this subject based on the ideXlab platform.
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time trend analysis on The framingham risk score and prevalence of cardiovascular risk factors in patients undergoing percutaneous coronary intervention without prior history of coronary vascular disease over The last 17 years a study from The Mayo Clinic pci registry
Clinical Cardiology, 2014Co-Authors: Ryan J Lennon, Charanjit S Rihal, David R Holmes, Moo Sik Lee, Andreas J Flammer, Mandeep Singh, Amir LermanAbstract:Background There is a paucity of data on The temporal trends of cardiovascular risk factors in patients undergoing percutaneous coronary intervention (PCI). We investigated The secular trends of risk profiles of patients undergoing PCI without prior history of cardiovascular disease (CVD). HypoThesis CVD risk factors are changed over time. Methods This time-trend analysis from 1994 to 2010 was performed within The Mayo Clinic PCI Registry. Outcome measures were prevalence of CVD risk factors, including The Framingham risk score (FRS), at The time of admission for PCI. Results During this period, 12,055 patients without a history of CVD (mean age, 65.0 ± 12.4 years, 67% male) underwent PCI at The Mayo Clinic. Age distribution slightly shifted toward older age (P for trend <0.05), but sex did not change over time. Despite a higher prevalence of hypertension, hypercholesterolemia, and diabetes mellitus over time, actual blood pressure and lipid profiles improved (P for trend <0.001). Over time, FRS and 10-year CVD risk improved significantly (7.3 ± 3.2 to 6.5 ± 3.3, P for trend <0.001; and 11.0 to 9.0, P for trend <0.001, respectively). Body mass index, not included in The FRS, increased significantly (29.0 ± 5.2 to 30.1 ± 6.2 kg/m2, P for trend <0.001), whereas smoking prevalence did not change. Conclusions The current study demonstrates that although traditional FRS and its associated predicted 10-year cardiovascular risk declined over time, The prevalence of risk factors increased in patients undergoing PCI. The study suggests The need for a new risk-factor assessment in this patient population.
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systems of care to improve timeliness of reperfusion Therapy for st segment elevation myocardial infarction during off hours The Mayo Clinic stemi protocol
Jacc-cardiovascular Interventions, 2008Co-Authors: David R Holmes, Luis H Haro, Christine M Bjerke, Ryan J Lennon, Malcolm R Bell, Charanjit S Rihal, Bernard J. Gersh, Choon Chern Lim, Henry H TingAbstract:Objectives We implemented The Mayo Clinic ST-segment elevation myocardial infarction (STEMI) protocol and evaluated The timeliness of reperfusion Therapy during off hours versus regular hours. Background Patients with STEMI who present during off hours have longer door-to-balloon times and door-to-needle times. Methods The Mayo STEMI protocol was implemented in May 2004 to optimize timeliness of reperfusion Therapy for STEMI patients presenting to Saint Marys Hospital, a tertiary facility with on-site percutaneous coronary intervention (PCI), and for those presenting to 28 regional hospitals located up to 150 miles away from Saint Marys Hospital. We compared door-to-balloon times and door-to-needle times for 597 consecutive patients who presented during off hours (weekdays from 5 pm to 7 am and any time on weekends or holidays) versus regular hours (weekdays from 7 am to 5 pm). In 2003, prior to implementing The protocol, median door-to-balloon time at Saint Marys Hospital was 85 min during regular hours and 98 min during off hours. Results Among 258 patients who presented to Saint Marys Hospital, median door-to-balloon time was 65 min during regular hours versus 74 min during off hours (p = 0.085). Among 105 patients transferred from regional hospitals for primary PCI, median door-to-balloon time was 118 min during regular hours versus 114 min during off hours (p = 0.15). Among 131 patients treated with fibrinolytic Therapy at regional hospitals, median door-to-needle time was 21 min during regular hours versus 26 min during off hours (p = 0.067). Conclusions The Mayo Clinic STEMI protocol demonstrates The rapid times that can be achieved through coordinated systems of care for STEMI patients presenting during off hours and regular hours.
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regional systems of care to optimize timeliness of reperfusion Therapy for st elevation myocardial infarction The Mayo Clinic stemi protocol
Circulation, 2007Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R BellAbstract:Background— Quality improvement efforts have focused on strategies to improve The timeliness of reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize The timeliness of reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. Methods and Results— The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Mar...
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regional systems of care to optimize timeliness of reperfusion Therapy for st elevation myocardial infarction The Mayo Clinic stemi protocol
Circulation, 2007Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R BellAbstract:BACKGROUND: Quality improvement efforts have focused on strategies to improve The timeliness of reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize The timeliness of reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. METHODS AND RESULTS: The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Marys Hospital and were treated with primary PCI (group A), 105 patients who presented to a regional hospital with symptom onset >3 hours and Then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset <3 hours and were treated with full-dose fibrinolytic Therapy (group C). For groups A and B, median door-to-balloon times were 71 and 116 minutes, respectively. Door-to-balloon time <90 minutes was achieved in 75% of group A and 12% of group B. Median door-to-needle time was 25 minutes for group C, and 70% had door-to-needle time <30 minutes. CONCLUSIONS: The Mayo Clinic ST-elevation myocardial infarction protocol demonstrates The feasibility of implementing strategies to optimize The timeliness of reperfusion Therapy and The times that can be achieved through coordinated systems of care for ST-elevation myocardial infarction patients presenting to a PCI center (Saint Marys Hospital) and 28 regional hospitals without PCI capability located up to 150 miles away across 3 states.
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trends in outcomes after percutaneous coronary intervention for chronic total occlusions a 25 year experience from The Mayo Clinic
Journal of the American College of Cardiology, 2007Co-Authors: Abhiram Prasad, Ryan J Lennon, Charanjit S Rihal, Heather J Wiste, Mandeep Singh, David R HolmesAbstract:Objectives The aim of our study was to examine The trends in procedural success, in-hospital, and long-term outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) over The last 25 years from a single PCI registry and to examine The impact of drug-eluting stents. Background The percutaneous treatment of CTO remains a major challenge. Past studies have used variable definitions of CTO, and There are limited data available from contemporary practice. Methods We evaluated The outcomes of 1,262 patients from The Mayo Clinic registry who required PCI for a CTO. The patients were divided into 4 groups according to The time of Their intervention: group 1 (percutaneous transluminal coronary angioplasty era), group 2 (early stent era), group 3 (bare-metal stent era), and group 4 (drug-eluting stent era). Results Procedural success rates were 51%, 72%, 73%, and 70% (p Conclusions Procedural success rates for CTO have not improved over time in The stent era, highlighting The need to develop new techniques and devices. Compared with The prestent era, in-hospital major adverse cardiac events and 1-year target vessel revascularization rates have declined by approximately 50%.
Malcolm R Bell - One of the best experts on this subject based on the ideXlab platform.
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pharmacoinvasive and primary percutaneous coronary intervention strategies in st elevation myocardial infarction from The Mayo Clinic stemi network
American Journal of Cardiology, 2016Co-Authors: Ryan J Lennon, Malcolm R Bell, Konstantinos C Siontis, Gregory W Barsness, Jody L Holmen, Scott R Wright, Bernard J. GershAbstract:The effectiveness of a pharmacoinvasive strategy consisting of fibrinolysis and transfer for percutaneous coronary intervention (PCI) compared to primary PCI (PPCI) in patients presenting to non–PCI-capable hospitals with ST-elevation myocardial infarction (STEMI) is not well defined. We analyzed data from The Mayo Clinic STEMI database of patients treated with a pharmacoinvasive strategy (favored in those presenting early after symptom onset) or PPCI in a regional STEMI network from 2004 to 2012. A total of 364 and 1,337 patients were included in The pharmacoinvasive and PPCI groups, respectively. Patients in The PPCI group were older and more frequently had cardiogenic shock at The time of presentation (12.1% vs 7.7%, p = 0.018). Death from any cause occurred in 58 (16%) and 314 (23%) patients in The pharmacoinvasive and PPCI groups, respectively (median follow-up 3.9 and 4.4 years, respectively). In multivariate analyses adjusting for age, gender, and oTher variables for which The 2 groups differed at baseline, There was no significant difference between The 2 strategies for 30-day (hazard ratio 0.66, 95% confidence interval 0.36 to 1.21) or overall mortality (hazard ratio 0.84, 95% confidence interval 0.63 to 1.12). Shorter door-to-balloon time was associated with increased effectiveness of PPCI (p for trend = 0.015), but There was no difference between The 2 strategies even when considering only The patients with door-to-balloon time in The lowest quartile. In conclusion, fibrinolysis followed by transfer for PCI represents a reasonable alternative when PPCI is not readily available especially in patients presenting early after symptom onset.
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systems of care to improve timeliness of reperfusion Therapy for st segment elevation myocardial infarction during off hours The Mayo Clinic stemi protocol
Jacc-cardiovascular Interventions, 2008Co-Authors: David R Holmes, Luis H Haro, Christine M Bjerke, Ryan J Lennon, Malcolm R Bell, Charanjit S Rihal, Bernard J. Gersh, Choon Chern Lim, Henry H TingAbstract:Objectives We implemented The Mayo Clinic ST-segment elevation myocardial infarction (STEMI) protocol and evaluated The timeliness of reperfusion Therapy during off hours versus regular hours. Background Patients with STEMI who present during off hours have longer door-to-balloon times and door-to-needle times. Methods The Mayo STEMI protocol was implemented in May 2004 to optimize timeliness of reperfusion Therapy for STEMI patients presenting to Saint Marys Hospital, a tertiary facility with on-site percutaneous coronary intervention (PCI), and for those presenting to 28 regional hospitals located up to 150 miles away from Saint Marys Hospital. We compared door-to-balloon times and door-to-needle times for 597 consecutive patients who presented during off hours (weekdays from 5 pm to 7 am and any time on weekends or holidays) versus regular hours (weekdays from 7 am to 5 pm). In 2003, prior to implementing The protocol, median door-to-balloon time at Saint Marys Hospital was 85 min during regular hours and 98 min during off hours. Results Among 258 patients who presented to Saint Marys Hospital, median door-to-balloon time was 65 min during regular hours versus 74 min during off hours (p = 0.085). Among 105 patients transferred from regional hospitals for primary PCI, median door-to-balloon time was 118 min during regular hours versus 114 min during off hours (p = 0.15). Among 131 patients treated with fibrinolytic Therapy at regional hospitals, median door-to-needle time was 21 min during regular hours versus 26 min during off hours (p = 0.067). Conclusions The Mayo Clinic STEMI protocol demonstrates The rapid times that can be achieved through coordinated systems of care for STEMI patients presenting during off hours and regular hours.
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regional systems of care to optimize timeliness of reperfusion Therapy for st elevation myocardial infarction The Mayo Clinic stemi protocol
Circulation, 2007Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R BellAbstract:Background— Quality improvement efforts have focused on strategies to improve The timeliness of reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize The timeliness of reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. Methods and Results— The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Mar...
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regional systems of care to optimize timeliness of reperfusion Therapy for st elevation myocardial infarction The Mayo Clinic stemi protocol
Circulation, 2007Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R BellAbstract:BACKGROUND: Quality improvement efforts have focused on strategies to improve The timeliness of reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize The timeliness of reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. METHODS AND RESULTS: The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Marys Hospital and were treated with primary PCI (group A), 105 patients who presented to a regional hospital with symptom onset >3 hours and Then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset <3 hours and were treated with full-dose fibrinolytic Therapy (group C). For groups A and B, median door-to-balloon times were 71 and 116 minutes, respectively. Door-to-balloon time <90 minutes was achieved in 75% of group A and 12% of group B. Median door-to-needle time was 25 minutes for group C, and 70% had door-to-needle time <30 minutes. CONCLUSIONS: The Mayo Clinic ST-elevation myocardial infarction protocol demonstrates The feasibility of implementing strategies to optimize The timeliness of reperfusion Therapy and The times that can be achieved through coordinated systems of care for ST-elevation myocardial infarction patients presenting to a PCI center (Saint Marys Hospital) and 28 regional hospitals without PCI capability located up to 150 miles away across 3 states.
